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Do hilar clamping and renorrhaphy influence postoperative renal function after partial nephrectomy?
Masaki Nakamura1, Ibuki Tsuru1, Yoshiyuki Shiga1
1Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan.
GHM Open
|March 27, 2025
Summary
For partial nephrectomy (PN) in renal tumors, omitting renorrhaphy is safe and preserves renal function. Hilar clamping does not impact kidney function, but renorrhaphy may worsen it.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Preserving renal function is a key objective in partial nephrectomy (PN) for renal tumors.
- Techniques like hilar control and omitting renorrhaphy aim to improve postoperative renal function but their impact remains debated.
Purpose of the Study:
- To review the current literature on PubMed regarding surgical techniques in PN.
- To clarify the influence of hilar control and renorrhaphy on postoperative renal function.
Main Methods:
- A literature review was conducted using PubMed.
- Studies examining the effects of hilar clamping, omission of renorrhaphy, and their combination on postoperative renal function were analyzed.
Main Results:
- Hilar clamping showed no significant impact on postoperative renal function.
- Cortical renorrhaphy was associated with a tendency towards deteriorating renal function.
- Recent studies indicate no difference in renal function between on-clamp and off-clamp laparoscopic PN.
- Soft coagulation, despite causing parenchymal changes, may benefit renal function due to shortened warm ischemia time.
Conclusions:
- Off-clamp, non-renorrhaphy PN is a feasible and safe approach for small renal tumors.
- Renorrhaphy, unlike hilar clamping, tends to negatively affect postoperative renal function.
